SHA vs NHIF: what changed for you and your family

SHA vs NHIF: what actually changed

NHIF was a hospital insurance fund. Members paid a monthly amount, mostly according to salary bands, and the fund paid for treatment at accredited hospitals under various schemes. Over the years it grew into a patchwork of schemes for civil servants, the self-employed and others, each with its own rules.

The Social Health Insurance Act replaced NHIF with the Social Health Authority and a set of funds with clearer jobs. A Primary Healthcare Fund pays for care at the community and dispensary level, so that basic outpatient care is covered for everyone registered. The Social Health Insurance Fund pays for treatment at higher levels, such as admissions and specialist care. A separate fund covers emergencies, chronic illness and critical conditions such as cancer and kidney failure.

The second big change is that membership is meant to be universal. Under NHIF, many people outside formal employment never joined. Under SHA every resident is expected to register, and contributions are linked to household income rather than flat bands.

The third change is in how you are identified. SHA uses your national ID number rather than a membership card. When you visit a facility, your ID is used to confirm that you are registered and that your contributions are up to date. Old NHIF cards are not what a hospital checks any more.

Finally, the way facilities are paid changed, and with it the list of facilities that accept SHA. A hospital that worked with NHIF is not automatically contracted under SHA. Before planned treatment, check that the facility is contracted, and what it is contracted for.

Contributions for employed and self-employed people

For employed people, the contribution is a percentage of gross salary, deducted by the employer and sent to SHA, much as NHIF was. The rate set when SHA started was 2.75% of gross pay, with a minimum monthly amount. For most salaried people this changed the amount they pay compared with the old NHIF bands; for higher earners it went up noticeably.

For people outside formal employment, such as farmers, traders, boda boda riders and freelancers, the contribution is based on an assessment of household income. SHA uses information you provide, and other data, to work out what the household can pay. The contribution can be paid in different ways, including through mobile money.

The household, not the individual, is the unit for most self-employed people. One person, usually the head of the household, registers and pays for the household, and the spouse and children are listed as dependants. If both spouses earn, how they register affects what the household pays, so it is worth getting it right at the start.

Contributions must be current for cover to work. Under the rules, being behind on contributions can stop SHA from paying for treatment beyond primary care until the arrears are cleared. Unlike NHIF, where some people only paid when they needed treatment, SHA expects regular payment.

People who cannot pay are meant to be supported by government. Households identified as unable to contribute can have their contributions paid for them. If this applies to you, the registration and means assessment is still the first step.

How a spouse and children are covered

Dependants are covered through the principal member. A spouse and children are added to the principal's registration, and they are covered as long as the principal's contributions are current. Adding them is not automatic: a family member who is not listed is not covered, even if the principal pays every month.

To add a spouse you will usually need their ID number and evidence of the marriage, such as a marriage certificate or an affidavit, depending on the type of marriage. Children are added with their birth certificate numbers. A child who does not yet have a birth certificate is harder to add, which is one more reason to register births promptly.

Children stay covered as dependants up to a certain age, with an older limit for children still in education and no limit for children with disabilities who depend on their parents. Once a young person is working, they register as a member in their own right.

Families with two earners should decide who the principal member is and list the children once. Listing the same child under both parents causes mismatches, and correcting it later takes longer than doing it once at the start. Our SHA registration service registers the principal member and adds the spouse and children in one go.

Why registering properly matters now

The moment people discover registration problems is the worst moment: at the hospital, often in an emergency, when the facility checks the ID and finds the person is not registered, a dependant is missing, or contributions are behind. Fixing that at the counter is stressful and sometimes impossible on the day.

Check your registration while you are well. Confirm that you are registered, that your dependants are listed with the right details, that your contributions show as paid, and that your phone number on the record is one you still use. SHA uses it for confirmations, and an old number can lock you out of your own record.

Employees should check that their employer is deducting and remitting SHA contributions. A deduction on your payslip that never reached SHA leaves you uncovered, and it is your treatment that is affected. If anything looks wrong, raise it with HR first.

Social protection works best as a whole. Health cover through SHA and retirement savings through NSSF are separate, and many people are behind on one without knowing. Our guide to NSSF contribution rates explains the other half.

Common questions